| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item nos each |
2,497 |
2,155 |
$135K |
| A4554 |
Disposable underpads |
2,113 |
1,883 |
$90K |
| T4527 |
Adult size pull-on lg |
708 |
622 |
$82K |
| T4523 |
Adult size brief/diaper lg |
454 |
431 |
$56K |
| T4526 |
Adult size pull-on med |
26 |
24 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
999 |
358 |
$1K |
| E0601 |
Cont airway pressure device |
45 |
30 |
$1K |
| E0570 |
Nebulizer with compression |
1,188 |
308 |
$463.90 |
| K0001 |
Standard wheelchair |
1,166 |
337 |
$370.42 |
| A4253 |
Blood glucose/reagent strips |
787 |
313 |
$303.76 |
| K0003 |
Lightweight wheelchair |
325 |
63 |
$124.42 |
| Q0513 |
Disp fee inhal drugs/30 days |
370 |
68 |
$120.81 |
| E1390 |
Oxygen concentrator |
135 |
69 |
$99.79 |
| E0562 |
Humidifier heated used w pap |
42 |
29 |
$48.96 |
| E1038 |
Transport chair pt wt<=300lb |
706 |
173 |
$34.70 |
| A7015 |
Aerosol mask used w nebulize |
560 |
104 |
$14.89 |
| A4256 |
Calibrator solution/chips |
549 |
231 |
$9.11 |
| A7003 |
Nebulizer administration set |
605 |
118 |
$8.20 |
| A4259 |
Lancets per box |
771 |
311 |
$6.93 |
| J7613 |
Albuterol non-comp unit |
73 |
12 |
$5.21 |
| 0003A |
|
106 |
86 |
$0.00 |
| E0630 |
Patient lift hydraulic |
171 |
53 |
$0.00 |
| A4258 |
Lancet device each |
33 |
23 |
$0.00 |
| E0143 |
Walker folding wheeled w/o s |
54 |
13 |
$0.00 |